WAC 296-23A-0220. How does the department pay for hospital outpatient services?

The department will pay for hospital outpatient services according to the following table: Hospital Type or Service Location Does the Ambulatory Payment Classification System apply? Do percent of allowed charges (POAC) payment methods apply? Do the department's Medical Aid Rules and Fee Schedules apply to hospital outpatient radiology, laboratory, pathology, occupational therapy, and physical therapy services? Children's hospitals No Yes, paid 100% of allowed charges Yes Chronic Pain Management Program No Exempt, paid per department agreement Exempt, paid per department agreement Health Maintenance Organizations Yes, paid statewide average per APC rate Yes, applies to certain hospital outpatient services excluded from OPPS except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Military No Yes, paid 100% of allowed charges No, paid 100% of allowed charges Veterans Administration No Yes, paid 100% of allowed charges No, paid 100% of allowed charges State psychiatric facility No Yes, paid 100% of allowed charges Yes Other psychiatric hospitals No Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Rehabilitation hospitals No Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Cancer hospitals No Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Critical access hospitals No Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes All other Washington hospitals Yes Yes, applies to certain hospital outpatient services excluded from OPPS except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Hospital Type or Service Location Does the Ambulatory Payment Classification System apply? Do percent of allowed charges (POAC) payment methods apply? Do the department's Medical Aid Rules and Fee Schedules apply to hospital outpatient radiology, laboratory, pathology, occupational therapy, and physical therapy services? Children's hospitals No Yes, paid 100% of allowed charges Yes Chronic Pain Management Program No Exempt, paid per department agreement Exempt, paid per department agreement Health Maintenance Organizations Yes, paid statewide average per APC rate Yes, applies to certain hospital outpatient services excluded from OPPS except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Military No Yes, paid 100% of allowed charges No, paid 100% of allowed charges Veterans Administration No Yes, paid 100% of allowed charges No, paid 100% of allowed charges State psychiatric facility No Yes, paid 100% of allowed charges Yes Other psychiatric hospitals No Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Rehabilitation hospitals No Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Cancer hospitals No Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Critical access hospitals No Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes All other Washington hospitals Yes Yes, applies to certain hospital outpatient services excluded from OPPS except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Hospitals are reimbursed only for the technical component of rates listed in the fee schedules, for outpatient radiology, pathology and laboratory services. See chapter 296-23 WAC for rules on radiology, pathology, laboratory, physical therapy, occupational therapy, and work hardening services. See WAC 296-23A-700 for rules on prospective payment system for hospital outpatient services. See WAC 296-20-132 and 296-20-135 for information on the conversion factor used for certain hospital outpatient services.